Public Service Requests List
Intended use of the information
What form of media do you want your information?
Type of voter records requested (please be as specific as possible)
By placing your initials below you agree that under penalty of perjury, I declare that no part of any list requested by this application is intended to be used for commercial solicitation or for any other purpose that is not related to the election process. I am aware that if I or any other person who has a registration list under his or her control knowingly allows any part of that list to be used for commercial solicitation or for any other purpose that is not related to the election process, that individual is guilty of a misdemeanor and, on conviction, subject to imprisonment for not less then 30 days or more than 6 months, to a fine of up to $250, or both imprisonment and fine.
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